Our patient's clinical course suggests that high doses of B vitamins (FA/folate and vitamin Btwelve) may modulate the course of PSA failure in castrate-resistant/refractory prostate cancer. Our patient's ingestion of large amounts of FA/folate and vitamin B12 was associated with PSA acceleration, while withdrawal of the supplements was associated with a significant PSA decline. Whether this result was secondary to the perturbation of the outlined metabolic interactions of B vitamers (Figure 2), due to DNA epimethylation with associated changes in gene expression, or due to other factors is unknown. The hypothesis of a yet to be discovered interaction with docetaxel is entertained as well. Studies of patient use of health store supplements, many of which are known to affect DNA metabolism and DNA methylation markers, have revealed that up to 50% of cancer patients ingest large doses of vitamins and other supplements, such as probiotics, which contain "safe" bacteria that generate copious amounts of folates within the bowel. A recent study in our clinic revealed that a majority of cancer patients present with hypervitaminosis or hypovitaminosis of at least one or more of the B vitamins noted in Figure 2. As we have discussed herein, castration, drugs, diet, vitamin supplements, and probiotics may modulate tumor cell metabolism as well as gene expression by epimethylation and synthesis of DNA. We are concerned about the finding that many gas stations and liquor stores in the USA sell so-called "quick energy" liquid supplements that contain large amounts of B vitamins, including vitamins Bsix and B12 and FA.
Person's position
"I was alarmed to see a steady increase in my PSA while undergoing chemotherapy. I had been taking a dietary supplement containing large amounts of vitamin B12 and folate. My wife and I searched the Internet to find foods that were low in natural folate, and avoided those foods high in folate. When I found out the government had mandated the addition of folic acid to basically all products containing flour and grains since 1998 I was surprised and dismayed. We quickly learned to read the food content labels on packaging, and found that many foods contained folic acid. Avoiding folic acid supplemented foods meant that nearly all baked goods, cereals, crackers, pasta, egg noodles, stuffing mix, white rice, bagels, flour tortillas, sandwiches, burger rolls, dinner rolls, doughnuts, pizza, pies and cakes were off limits. My wife, who loves to bake, found organic flour that was not supplemented, and used that exclusively to make bread, cookies, pies, cakes, pizza dough, etc. Happily, doing something as simple as reducing FA intake, allowed the chemotherapy to rapidly reduce my PSA to the lowest level in years."
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